Original Research Reports A Collaborative Care Depression Management Program for Cardiac Inpatients: Depression Characteristics and In-Hospital Outcomes Jeff C. Huffman, M.D., Carol A. Mastromauro, L.I.C.S.W., Gillian L. Sowden, B.A., Curtis Wittmann, M.D., Rachel Rodman, L.I.C.S.W., James L. Januzzi, M.D. Background: Depression in cardiac patients is com- mon, under-recognized, and independently associated with mortality. Objectives: Our objectives in this initial report from a 6-month longitudinal trial were to deter- mine whether a collaborative care program improves rates of depression treatment by discharge among pa- tients hospitalized with acute cardiovascular disease, and to assess key clinical characteristics of depression in this cohort. Method: This was a prospective, ran- domized trial comparing collaborative care and usual care interventions for depressed cardiac patients who were admitted to cardiac units in an urban academic medical center. For collaborative care subjects, the care manager performed a multi-component depression inter- vention in the hospital that included patient education and treatment coordination; usual care subjects’ inpa- tient providers were informed of the depression diagnosis. Results: The mean Patient Health Question- naire-9 for subjects (N = 175) was 17.6 (SD 3.5; range 11–26), consistent with moderate-severe depression. The majority of subjects had depression for over one month (n = 134; 76.6%) and a prior depressive episode (n = 124; 70.8%); nearly one-half (n = 75; 42.9%) had thoughts that life was not worth living in the preceding 2 weeks. Collaborative care subjects were far more likely to receive adequate depression treatment by dis- charge (71.9% collaborative care vs. 9.5% usual care; p  0.001). Conclusion: Depression identified by sys- tematic screening in hospitalized cardiac patients ap- pears was prolonged, and of substantial severity. A col- laborative care depression management model appears to vastly increase rates of appropriate treatment by dis- charge. (Psychosomatics 2011; 52:26 –33) D epression in patients with acute cardiovascular disease is common and associated with negative medical outcomes. For example, among patients hospi- talized for myocardial infarction (MI), unstable angina (UA), or congestive heart failure (CHF), depressive symptoms and clinical depression have been consis- tently and independently associated with mortality, re- current cardiac events, and poor health-related quality of life (HRQoL) over the following year. 1–4 Despite its substantial impact on medical outcomes, however, de- pression goes unrecognized and untreated in the vast majority of hospitalized cardiac patients. 5,6 Fortunately, when depression is identified in cardiac patients, standard treatments for depression are safe and efficacious. 7,8 To improve the recognition and treatment of depression in patients with cardiovascular disease, the Received May 7, 2010; revised May 26, 2010; accepted May 28, 2010. From Harvard Medical School, Boston, MA (JCH, GLS, CW, JLJ); Division of Cardiology, Massachusetts General Hospital, Boston, MA (JLJ); Depart- ment of Psychiatry, Massachusetts General Hospital, Boston, MA (JCH, CAM, CW, RR). Send correspondence and reprint requests to Dr. Jeff C. Huffman, M.D., Massachusetts General Hospital, 55 Fruit Street/Blake 11, Boston, MA 02114. e-mail: jhuffman@partners.org © 2011 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved. Psychosomatics 2011:52:26 –33 © 2011 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved. 26 http://psy.psychiatryonline.org Psychosomatics 52:1, January-February 2011